THE EFFECT OF ANTIRETROVIRAL THERAPY ON PRETERM BIRTH IN A U.S POPULATION OF WOMEN LIVING WITH HIV: A REEXAMINATION OF ANALYSIS METHODS

Harmful effects of combination antiretroviral therapy (cART) in pregnancy is a research priority given its widespread use in preventing vertical transmission of HIV. Studies investigating the relationship between ART and preterm birth (PTB) offer conflicting results as to whether PI cART is harmful in causing PTB, likely due to methodological challenges and not truly harmful effects. Our study reexamines methods used in the literature with the Women and Infants Transmission Study data (WITS). WITS is a US-based observational cohort designed to study the natural course of maternal-infant HIV-1 infection between 1990 and 2005. Exposure categories considered for both aims are no therapy, Zidovudine (ZDV) monotherapy; PI-based cART and non-nucleoside reverse transcriptase inhibitor (NNRTI) cART. For Aim 1, we used the complement of the Kaplan-Meier estimator and inverse probability weights to estimate PTB risk by time-varying exposure. A total of 1,067 HIV-positive pregnancies in 932 women were followed until delivery. The weighted risk differences indicated PI cART was harmful compared to NNRTI cART in preventing PTB, though insignificant. Exposure to either combination therapy were significantly associated in preventing very preterm compared to other exposures. For Aim 2, we demonstrated target trial emulation to examine the intention-to-treat effect of exposure on PTB. Women were enrolled and assigned treatment between 18 and 22 weeks to emulate trial enrollment at 20 weeks. We assumed that exposure assignment was conditional on measured baseline covariates to emulate baseline randomization. Log-Poisson models with robust variance estimators were used to report risk and risk ratios with 95% confidence intervals. Two hundred and six women were assigned their enrollment exposure. After adjusting for baseline covariates, women starting PI cART at 20 weeks had increased risk of PTB when compared to all other exposures, though all effect estimates were statistically insignificant. This finding is contrary to what is established in the ART literature. Although the WITS was not the ideal candidate for demonstrating the use of survival analysis or target trial emulation, both methods can accommodate the realities of observational cohort data and should be considered as an alternative to conventional binary methods.Doctor of Philosoph

Overestimation of Vitamin a Supplementation Coverage from District Tally Sheets Demonstrates Importance of Population-Based Surveys for Program Improvement: Lessons from Tanzania.

Tanzania has conducted a national twice-yearly Vitamin A supplementation (VAS) campaign since 2001. Administrative coverage rates based on tally sheets consistently report >90% coverage; however the accuracy of these rates are uncertain due to potential errors in tally sheets and their aggregation, incomplete or inaccurate reporting from distribution sites, and underestimating the target population. The post event coverage survey in Mainland Tanzania sought to validate tally-sheet based national coverage estimates of VAS and deworming for the June 2010 mass distribution round, and to characterize children missed by the national campaign. WHO/EPI randomized cross-sectional cluster sampling methodology was adapted for this study, using 30 clusters by 40 individuals (n = 1200), in addition to key informant interviews. Households with children 6-59 months of age were included in the study (12-59 months for deworming analysis). Chi-squared tests and logistic regression analysis were used to test differences between children reached and not reached by VAS. Data was collected within six weeks of the June 2010 round. A total of 1203 children, 58 health workers, 30 village leaders and 45 community health workers were sampled. Preschool VAS coverage was 65% (95% CI: 62.7-68.1), approximately 30% lower than tally-sheet coverage estimates. Factors associated with not receiving VAS were urban residence [OR = 3.31; p = 0.01], caretakers who did not hear about the campaign [OR = 48.7; p<0.001], and Muslim households [OR<3.25; p<0.01]. There were no significant differences in VAS coverage by child sex or age, or maternal age or education. Coverage estimation for vitamin A supplementation programs is one of most powerful indicators of program success. National VAS coverage based on a tally-sheet system overestimated VAS coverage by ∼30%. There is a need for representative population-based coverage surveys to complement and validate tally-sheet estimates

Health promotion activity in Kampung Kukut, Beaufort

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Flow of participants in final analytical sample.

<p>Flow of participants in final analytical sample.</p

Knowledge of Vitamin A Among Village Leaders, Healthcare Workers and Community Health Workers.

<p>*Village leaders were not asked questions pertaining to methods of combatting VAD</p

Effect of enhanced detailing and mass media on community use of ORS and zinc during a scale-up program in Gujarat and Uttar Pradesh

These data and do files are associated with the paper "Effect of enhanced detailing and mass media on community use of ORS and zinc during a scale-up program in Gujarat and Uttar Pradesh" by Felix Lam, George Pro, Shreya Agrawal, Vishal Shastri, Leslie Wentworth, Melinda Stanley, Nitin Beri, Abhishek Tupe, Ashutosh Mishra, Hamsa Subramaniam, Kate Schroder, Marta Rose Prescott, and Naresh Trikha, published in the Journal of Global Health. They include outcomes of interest, socio-demographic variables, and other variables necessary to replicate the study

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial

<div><p>Introduction</p><p>In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence.</p><p>Methods</p><p>Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention’s impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services.</p><p>Results</p><p>The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; <i>P</i> = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (<i>P</i> = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2–48.5; <i>P</i> = 0.2).</p><p>Conclusion</p><p>A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia’s urban clinics.</p></div

The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi

U radu je obrađen i analiziran sustav za metalizaciju varistora. Obrađen je kompletan proces od stavljanja samog varistora u „TCP kalup“ do same metalizacije i sušenja komada također kao i automatizacija cijelog procesa. Tijekom prakse promatran je rad stroja i njegove funkcije i crtan je nosač kalupa (TCP) u solidworks-u koji se stavlja u stroj. Obrađen je samo dio cijele proizvodnje i postupka metalizacije točnije obrađen je dio metalizacije (vakumsko uranjanje) srebrom. Tijekom prakse promatran je rad stroja i njegove funkcije. Promatranjem je utvrđeno kako se sam proces izvodi i radi te koliko je automatizacija olakšala rad čovjeku. Zbog ograničenja i privatnosti tvrtke Selk d.d., postavljene su fotografije i određeni dijelovi posla koji su bili odobreni od strane mentora.The paper deals with the analysis of the varistor metallization system. The entire process was processed, from the insertion of the varistor itself into the "TCP mold" to the metallization and drying of the piece itself, as well as the automation of the whole process. During the practice, the operation of the machine and its function was observed and a mold carrier (TCP) was drawn in solidworks to be inserted into the machine. Only a part of the entire production and process of metallization were processed, more precisely the part of metallization (vacuum immersion) with silver was processed. During the practice, the operation of the machine and its function were observed. Observation determined how the process itself works and works and how much automation has made it easier for humans to work. Due to the limitations and privacy of Selk d.d., photographs were also posted of certain pieces of work that were approved by the mentor

Trial profile.

<p>Trial profile.</p